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EMERGENCY SURGICAL SERVICES

The Attending Doctors :

1. Ely Sakti Chief

2. Dian Arie Vice Chief

3. Ubaidillah II

4. M. Reza Febrian II

5. Alvin B II

6.

Jonata P III

7. Rahwanda S III

8. Diah M III

9. Fadil P IV

10. Hengky P IV

11. Agus J IV

12. A H Kuncoro V

13. Tunjung R V

14. Donny Sandra V

15. Andri Tio V

16. Luthfi VI

17. Irfan VI

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Thursday, January 9th 2014

TRAUMA CASES ( 5 )

1. Mr. Warso / ♂ / 60 years old

D/ Electric burn injury (T22)

2. Boy Decky / ♂ / 7 years old

D/ Closed mild head injury of GCS 14 (S06.0) + EDH of left temporal region (S06.4) +

cerebral edema (S06.1)

3. Dai Robi / ♂ / 17 years old

D/ Closed mild head injury of GCS 15 (S06.0) + lacerataed wound on right auricle 4. (S10.3)

4. Mr. A. Nekson / ♂ / 31 years old

D/ Ruptur ulnar artery and nerve (S64.0) + ruptur of the flexor tendon group (S66.1) +

fracture distal of left ulnar extra articuler (S52.6)

5. Dodi A / ♂ / 18 years old

D/ Closed moderate head injury of GCS 13 (S06.0) + ICH of left frontotemporal region

(S06.3) + cerebral edema (S06.1)

NON TRAUMA CASES ( 3 )

1. Mrs. Wella / ♀ / 33 years old

D/ Acute appendicitis (K35.0)

2. Mr. Khuzairin / ♂ / 57 years old

D/ Perforation of gaster (K.65) + susp malignancy of the liver (K76.8)

3. Mr. Yan R / ♂ / 50 years old

Right pleural efusion (J91)

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TRAUMA CASES

1. Mr. Warso / ♂ / 60 years old

Admitted on Thursday, January 9th 2014 at 01.20 PM

Anamnesis

Electric burn injury

While he was working at the roof, his shoulder got shocked by electric power.

(about 3 hours before admission)

Referred from Dr. Rivai Abdullah, Palembang.

PRIMARY SURVEY

A. Good

B. RR : 22 x/m

C. BP : 150/90 mmHg

PR : 78 x/m

SECONDARY SURVEY

There are burn injury :

- Face : 4 % grade IIA

- shoulder : 0,5 % grade IIB

- Right leg : 7 % grade IIA

0,5% grade IIB

Total : 11% grade IIA and

1 % grade IIB

Dark urine ( + )

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ECG:

Sinus rhythm

LABORATORY FINDING:

Hb : 14,1 gr/dl (14 – 18 g/dl)

Ht : 41 vol% (40 – 48 vol%)Leucosit: 22.800 /mm3 (5000- 10.000/mm 3)

BSS : 154 mg/dL

CK-NAC : 9602 U/L (39-308 U/L)

CK-MB : 290 U/L (7-25 U/L)

Urinalysis : Eritrosit 10-15 /HPF (0-1/HPF)

DIAGNOSIS

Electric burn injury (T22)

THERAPY

- IVFD RL gtt XX/m (1800 cc / 24 hour)

- NGT + Urethral catheter

-Ceftriaxon 1x2 g IV

- Ketorolac 3 x 30 mg IV

-ATS 1500 IU IM

-Serial ECG

-Debridement

2. Boy Decky / ♂ / 7 years old

Admitted on Thursday, January 9th 2014, at 02.49 PM

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ANAMNESIS

Pain on his head after having traffic accident

He was hit by a motorcycle while she was crossing the street, his head hit the hard thing.

(About 2 days before admission)

Referred from Charitas Hospital, Palembang.

PRIMARY SURVEY

A. Good

B. RR : 24 x/min

C. PR : 104 x/min

D. GCS : E3M6V5 = 14, pupils were isochors, light reflexes were positive on both eyes.

SECONDARY SURVEY

On the Left Temporal region

I : Hematoma ( + )

RADIOLOGICAL FINDINGS

Head CT-Scan : EDH of left temporal region + cerebral edema

LABORATORY FINDINGS

Hb : 10,9 gr/dl (14 – 18 gr/dl)

Ht : 32 % (40 – 48 %)

DIAGNOSIS

Closed mild head injury of GCS 14 (S06.0) + EDH of left temporal region ((S06.4)) +

cerebral edema (S06.1)

THERAPY

-

O2 mask 8 L/m

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- Head up 30°

- IVFD NaCl 0,9% gtt X/m (fluid demand 1500cc/day)

- Tramadol 3 x 15 mg IV

- Craniotomy emergency

IO :

- In the epidural space, we found blood and blood clot about 30 cc

- We evacuated blood and blod clot

-

We inserted one drain subgaleal

The patient was treated in the ER

3. Dai Robi / ♂ / 17 years old


ANAMNESIS

Pain on his head after having traffic accident

His motorcycle was hit by another motorcycle from front side. He fall and his head hit the

hard thing.

(About 4 hours before admission)

Referred from Bari Hospital, Palembang.

PRIMARY SURVEY

A. Good

B. RR : 20 x/min

C. BP : 110 / 70 mmHg

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- ATS 1500 IU IM

- Wound repair

4. Mr. A. Nekson / ♂ / 31 years old


ANAMNESIS

Slashed wound.

He got slashed by someone using machete on his left hand.

(About 2 hours before admission)

Referred from Khodijah Hospital, Palembang.

PRIMARY SURVEY

A. Good

B. RR : 20 x/min

C. BP : 130 / 80 mmHg

PR : 96 x/min

SECONDARY SURVEY

On the Left Hand Region

I : Wound about 7x2 cm, reguler edge, muscle based

P : Allen test ulnar artery (+)

Hiposensation of hypothenar area

ROM were limited

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O2 saturation digiti :

I : 99 %

II : 98 %

III : 99 %

IV : 99 %

V : 99 %


Left Hand X-Ray AP

Fracture distal ulnar extra articuler

LABORATORY FINDINGS

Hb : 11,3 gr/dl (14 – 18 gr/dl)

Ht : 33 % (40 – 48 %)

DIAGNOSIS

Ruptur ulnar artery and nerve (S64.0) + ruptur of the flexor tendon group (S66.1) + fracture

distal of left ulnar extra articuler (S52.6)

THERAPY

-

IVFD RL gtt XX/m (fluid demand 2100cc/day)

- Ceftriaxone 1 x 2 g IV

- Ketorolac 2 x 30 mg IV

- ATS 1500 IU IM

- Repair wound

-

Plan to perform ORIF

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IO :

Post operatively patient was treated in the ward

5. Dodi A / ♂ / 18 years old

Admitted on Friday, January 10th 2014, at 01.55 AM

ALLOANAMNESIS

Decreasing of conciousness after having traffic accident

His motorcycle got slipped, his fell and his head hit the hard thing.

(About 4 days before admission)

Referred from Dr. M. Yunus Hospital, Bengkulu.

PRIMARY SURVEY

A. Good

B. RR : 20 x/min

C. PR : 84 x/min

D. GCS : E3M6V4 = 13, pupils were isochors, light reflexes were positive on both eyes.

SECONDARY SURVEY

On the Left Frontal region

I : Hematoma ( + )


Head CT-Scan

ICH of left frontotemporal region + cerebral edema

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DIAGNOSIS

Closed moderate head injury of GCS 13 (S06.0) + ICH of left frontotemporal region (S06.2)

+ cerebral edema (S06.1)

THERAPY

- O2 mask 8 L/m

- Head up 30°

- IVFD NaCl 0,9% gtt XX/m (fluid demand 1500cc/day)


The patient was treated in the ER.

NON TRAUMA CASES

1. Mrs. Wella / ♀ / 33 years olds

Admitted on Thursday, January 9th 2014 at 10.50 AM

ANAMNESIS

Pain on right lower abdomen.

About 1 day before admission, she complained epigastric pain that move and stayed at right

lower abdomen. Nausea ( + ), decreasing of appetite ( + ), fever ( - ).

Referred from Bhayangkara Hospital, Palembang.

VITAL SIGNS

Sense = conscious

BP = 120/80 mmHg

PR = 88 x/m

RR = 20 x/m

T = 36.8 ºC

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- We perform appendectomy the tissue sent to PA

Post operative diagnosis : Acute appendicitis (K35.0)

The patient was treated in the ER

2. Mr. Khuzairin / ♂ / 57 years olds


ANAMNESIS

Pain on whole abdomen.

About 2 days before admission, he complained of pain on whole abdomen.

About 2 week before admission he complained of pain from epigastrium that move and

stayed at flank, nausea (+), vomite (-),

History of consumption reumatic medicine (+) since 1 month ago for the 2 weeks.

History right herniotomy 2010

Referred from Bhayangkara Hospital, Palembang.

VITAL SIGNS

Sense = conscious

BP = 140/90 mmhg

PR = 100 x/m

RR = 24 x/m

T = 36.8 ºC

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PHYSICAL EXAMINATION :

On the Abdominal Region

I : distended

P : defans muscular (+)

P : Tympani

A : Bowel sound (+) decrease

Right Inguinal region :

I : Scar op (+), Bulge that can reduce into abdominal cavity

NGT : greenish fluid

DRE : AST was good, mass (-),

ample wasn’t collapse

HS : Blood (-), feces (+)


3 Position Abdominal Plain X-Ray

Bowel distention (-)

Herring bone (-)

Air fluid level (-)

Free air (+)

LABORATORY FINDING

Hb : 12,9 g/dl (14 – 18 g/dl )

Ht : 38 % (40 – 48 %)

Leucosite : 21.500 /mm3 (5 – 10.103/mm 3)

Trombosit : 153.000 (150.000-400.000)

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Na : 131 mEq / dl (135-145)

K : 4,8 mEq / dl (3.5-5.0)

AGD

pH : 7,37 (7,35 – 7,45)

pCO2 : 29.9 mmHg (35 – 45 mmHg)

pO2 : 110.1 mmHg (83 – 108 mmHg)

HCO3 : 17.7 mmol/L (21 – 28 mmol/L)

BEecf : - 7.7 mmol/L (-2 sd +3 mmol/L)

SaO2 : 98,1 %

PaO2/FiO2 : 183,6 mmHg

IO :

- In the abdominal cavity we found gastric content and fibrin about 500 cc that came out from

gaster perforation at prepiloric part with Ø 1cm

- We excise the edge of perforation, and sutured with PGA 3.0 R interuptedly PA

- On further exploration, we found surface of hepar not smooth and increasing size of lien

hepar biopsi PA

- We cleansed the abdominal cavity using warm normal saline

- We inserted one drain intraperitoneal

POST OPERATIVE DIAGNOSIS : Perforation of gaster (K.65) + susp malignancy of the

liver (K76.8)

The patient was treated in the P1

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3. Mr. Yan R / ♂ / 50 years olds


ANAMNESIS

Shortness of breathing.

About 4 days before admission, he complained of shortness of breathing more severe.

About 3 months before admission, he complained of shortness of breathing. He got TB

medication for 3 months.

Referred from YK Madira Hospital, Palembang.

VITAL SIGNS

Sense = conscious

BP = 130/70 mmhg

PR = 94x/m

RR = 40 x/m

T = 36.9 ºC

PHYSICAL EXAMINATION :

On the Thoracic Region

I : simetric

P : sonor on left hemithorax, dullness on right hemithorax

A : vesicular ( + ) on left hemithorax, vesicular decreased on right hemithorax


Chest X-Ray

Radioopaque of right hemithorax (+)

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Chest CT Scan (RS Siloam)

Mass of right hemithorax (+)

DD/ Bronchogenic Ca / large cell Ca

DIAGNOSIS

Right pleural efusion (J91)

THERAPY

-

IVFD RL gtt XX/m (fluid demand 1800cc/day)

- Ceftriaxone 2 x 1 g IV

- Right chest tube initial : 700 cc serosanguinus

undulation : ( + )

air bubble : ( - )

exp bubble : ( - )

- Cultur of the effusion


Chest X-Ray Control

ess es 9 jan 2014

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